Abstract
QuestionWe evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae.Materials and methodsProspective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge.ResultsWe included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan.ConclusionsAmong critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was identified in December 2019 as the cause of coronavirus disease 2019 (COVID-19) [1]
The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45
The continuous predictor time to invasive mechanical ventilation (IMV) showed a nonlinear association with the risk of in-hospital mortality
Summary
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was identified in December 2019 as the cause of coronavirus disease 2019 (COVID-19) [1]. A far from negligible proportion of hospitalized patients (20–67%) may develop a more severe disease, resulting in acute respiratory distress syndrome (ARDS) [2, 3]. ARDS has González et al Critical Care 2022, 26(1): generated a surge of patients who require respiratory support with invasive or noninvasive mechanical ventilation (IMV and NIMV) [3, 4]. Respiratory impairment is very common in surviving critically ill patients with COVID-19 and well described [6,7,8,9]. The most frequent respiratory function abnormality (up to 82%) is an impairment in the carbon monoxide diffusing capacity (DLCO) [6]. A higher proportion of patients (up to 70%) present a reticular or fibrotic pattern on chest CT scans at follow-up [6]
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